Prevalence of Overweight and Obesity among Nurses in Bahrain: A Cross-Sectional Study

Abstract

Background: Despite the plethora of studies on obesity in nurses worldwide, there is a paucity of studies in the Gulf Cooperation Council countries (GCC) including Bahrain. This study aims to estimate the prevalence of overweight and obesity among nurses in Bahrain

Methods: We used secondary data from a study that examined musculoskeletal self-reported symptoms among nurses in Bahrain. The prevalence of overweight and obesity was determined by calculating the percentages of BMI using the World Health Organization classification.

Results: A total of 550 nurses participated in the study. Most were females (n=488, 89.1%), ages 31 to 40 (n=239, 43.8%). The mean BMI was 26.9 (±4.4). A total of 64.6% of nurses in Bahrain were overweight and obese. The prevalence of overweight and obesity was 43.2% and 21.4%, respectively. The prevalence of overweight and obesity is associated with nationality and shift work.

Conclusion: We used BMI to estimate the prevalence of overweight and obesity, which is widely used in the literature. However, BMI does not consider muscle mass, bone density, overall body composition, and racial and sex differences. Therefore, in future studies, body fat proportion and muscle mass need to be measured to estimate the prevalence and predict risks for disease development, morbidity, and mortality. Leaders in health care institutions and professional nursing organizations in Bahrain should consider ways to promote nurses’ health by improving working conditions and providing access to facilities that promote health and wellbeing.

Introduction

Obesity is a common and growing health problem worldwide with dire consequences for individuals. Obesity is defined as “abnormal or excessive fat accumulation that presents a risk to health” determined by a body mass index (BMI) of 30 kg/m3 or more, with a measurement of 25 to 30 classified as overweight [1]. Overweight and obesity are known to be a major contributor to noncommunicable diseases such as cardiovascular diseases, cancer, diabetes mellitus, gallbladder diseases; endocrine and metabolic diseases; osteoarthritis, pulmonary diseases in addition to social discrimination, psychological effects, and eating disorders [2]. Additionally, obesity poses a significant economic burden on individuals, families, and countries. In the United States, for example, the cost of chronic diseases caused by obesity and overweight in 2016 was $1.72 trillion, which is equivalent to 9.3% of the U.S. Gross Domestic Product (GDP) [3]. The World Obesity Federation predicts that 1 billion people globally will be living with obesity by 2030 [4]. A national survey involving 2,948 adults living in Bahrain found that 33.2% and 39.8% were overweight and obese, respectively, with a higher prevalence (42.8%) among the Bahraini. The prevalence of overweight in males was 36.1% vs. 29.7% in females. A total of 39.2% of male and 47.2% of female respondents were obese [5]. Based on these findings and the fact that the national survey reported that 32% of women and 25% of men were obese, it is evident that the overweight and obesity rate is on the rise among people in Bahrain [6].

Because obesity and overweight pose significant health issues, health care workers (HCWs) are uniquely positioned in terms of health promotion and disease prevention among their patients. Studies have shown that the rates of overweight and obesity in HCWs range from 25.3–36.5% and from 10.8–41.3%, respectively [6, 7, 8, 9]. The prevalence of obesity and overweight among HCWs is not constant. Two recent studies have indicated that nurses were found to have higher rates of overweight and obesity (50%, 25%) than doctors (7.6%) and other HCWs (42%, 14.5%) [8, 10]. In contrast, some studies reported a higher prevalence of overweight and obesity among doctors than among nurses ^[7,11]. Studies found that older, male, married nurses with a diploma or associate degree were more likely to be overweight or obese [7, 12]. In contrast, some studies found that female nurses are more likely to be overweight and obese than male nurses [13, 14].

Despite the plethora of studies on obesity in nurses worldwide, there is a paucity of studies in the Gulf Cooperation Council countries (GCC), and no study conducted in Bahrain was found. In attempts to address this gap, this study aims to assess the prevalence of overweight and obesity in nurses in Bahrain and the associated factors. As of April 2022, the total number of registered nurses in Bahrain was 1,0241 [15].

Methods

We used secondary data from a study that examined the prevalence of musculoskeletal self-reported symptoms among nurses in Bahrain [16]. This was a multicentre descriptive cross-sectional study of a sample of registered nurses from three hospitals and three peripheral centres (rehabilitation and artificial kidney dialysis unit). The participants in this study were asked to self-report their height in centimetres and weight in kilograms. Data were collected over two months, December 2018 and January 2019.

Study sample

The musculoskeletal self-reported symptoms study included all registered nurses, regardless of age, years of working experience, nationality, gender, work schedule, areas of practice, health status, and other factors that might be associated with overweight or obesity. The sample size of the study was determined based on the estimate of the prevalence of musculoskeletal self-reported symptoms in previous studies. Considering the same formula and 50% as an average for the prevalence of overweight and obesity in previous studies, the sample size required to estimate the prevalence of overweight and obesity would be 357. The participants from each area of practice were recruited using proportional quota nonprobability sampling. The sampling method involved two steps. The first step involved calculating the total population of nurses in each hospital and centre. The second step entailed dividing the total population of nurses in each hospital and centre into homogeneous strata according to the areas of practice.

Measurement of study outcomes

For this study, the World Health Organization’s classifications were used to determine underweight (BMI<18.5), normal (BMI=18.5-24.9), overweight (BMI=25.0–29.9), and ‘obese’ (BMI≥30). BMI was calculated using the following formula: BMI=kg/m², where kg is a person's weight in kilograms and m² is his or her height in metres squared.

Ethical approval

Ethical approval for the musculoskeletal self-reported symptoms study was obtained from the Research Ethics Committee at the Royal College of Surgeons in Ireland, Medical University of Bahrain. We obtained permission from the administrations at the study hospitals and centres to access and recruit the participants.

Data analysis 

The IBM Statistical Package for Social Science Statistics (SPSS) version 26.0 software was used to analyse the data. Descriptive statistics were used to describe the data. Chi-square tests were used to compare the subgroups and to detect any statistically significant difference in the prevalence of overweight and obesity.

Results

A total of 602 self-administered questionnaires were distributed. Five hundred fifty completed questionnaires were returned, for a response rate of 91%. The respondents ranged in age from 23 to 64 years, with a mean of 37.9±8.1 years. Most participants were females (n = 488, 89.1%), with a bachelor’s degree (n = 330, 61.6%), and married (n = 512, 93.6%). The nurses came from eight clinical areas. The majority of participants were registered nurses (n=499, 91.4%) and worked in medical wards (n = 170, 30.9%) with an average work experience of 13.8 years. (Table 1)

Table 1. Participants’ Demographic and Work Characteristics   (N= 550)

Prevalence of Overweight and Obesity

Using the WHO guidelines to classify the participants according to their weight profiles, the prevalence of overweight and obesity was 43.2% (n=216) and 21.4% (n=107), respectively. The mean BMI was 26.9 (±4.4). Participants with normal weight and underweight accounted for 34% and 1.4% of the study sample, respectively. Despite some casual variations in the prevalence rates across the demographic variables, none of them was statistically significant except for nationality. Males had a higher prevalence of overweight than female nurses. Non-Bahraini were found to have a significantly higher prevalence of overweight (55.6%, p<0.001). Despite some apparent differences in the prevalence rates across work variables, no statistically significant difference was detected except for shift work. Participants who worked 9 to 25 days of evening and night shift per month had a significantly higher prevalence of overweight than those who worked for 8 days or less, 165 (77.8%) vs. 47 (22.2%), p<0.0001. Additionally, participants who worked 9 to 25 days of evening and night shift work had a significantly higher prevalence of obesity than those who worked for 8 days or less, 68 (66%) vs. 35 (34%), p=0.0036. (Table 2).

Table 2. The relationship Between the Prevalence of Overweight & Obesity and Participants’ Demographics and Work Characteristics

*Statistically significant differences with Fisher’s exact test at Alpha 0.05

**Statistically significant differences with Chi-square test of independence at Alpha 0.05

Discussion

Our study assessed the prevalence of overweight and obesity among 550 registered nurses in three governmental hospitals. This is one of the few studies in the Arabian Gulf region, if not the first to determine overweight and obesity prevalence. Of the nurses working at the study sites, 43% were overweight, and 21% were obese. The prevalence of overweight and obesity in this study was consistent with the international literature and those from several previous studies using BMI as the estimated measure [17,18]. The prevalence of overweight and obesity was higher among nurses in this study than among those in Korea [19], Ghana [13], and Malaysia [20]. Studies in the UK [10], Scotland [17], and the United States reported a higher prevalence than our study.

Overweight was higher among male nurses than female nurses in our study. However, the difference was not statistically significant, which could be due to the low representation of males in the study sample. This finding is consistent with the Bahrain National Health Survey published in 2018 [5]. Of all Bahraini citizens, 36.1% of males were overweight compared to 29.7% of females. For non-Bahraini individuals, 42.9% of males were overweight compared to 33.8% of females. Many studies found the same results [7]. Additionally, in some regions around the globe, data suggest that the prevalence of obesity and overweight among males was much higher than in females [21]. One possible explanation for this is that musculoskeletal mass in men is greater than in women [22]. Regarding nationality, our study showed that non-Bahraini nurses had a higher prevalence of overweight, and the difference was statistically significant. Nationality may not be directly associated with the prevalence of overweight, but the lifestyle, dietary habits, and cultures of nurses from various countries may be influential factors.

The association between shift work and obesity among nurses has been extensively studied [23,24,25]. A recent systematic review and meta-analysis involving 11 studies reported a positive relationship between obesity and nurses’ shift work [26]. Our study found that nurses who worked more evening and night shifts per month had a higher prevalence of overweight and obesity. This finding supports the report from the systematic review. Some of the previous studies reported that obesity and overweight are higher in nurses than in other health care professionals [8,10,17]. Overweight and obesity harm nurses’ health and increase their risk for diabetes mellites, hypertension, cardiovascular diseases, and musculoskeletal complaints. BMI was found to be positively and significantly associated with systolic blood pressure among nurses [27]. A 30-year follow-up (1980-2010) from a prospective cohort “the Nurse Health Study” in the United States found that the cardiovascular disease risk of nurses with metabolically healthy obesity was increased compared with that of nurses with metabolically healthy normal weight [28]. In the Nurse Health Study, metabolic healthy obesity was defined as being obese but with the absence of diabetes, hypertension, and hyperlipidaemia.

The reasons for overweight and obesity among nurses who participated in the study are unknown. Further studies are required to assess risks and unhealthy behaviours contributing to overweight and obesity. Studies have shown that sleeping, exercise, and eating habits are associated with overweight and obesity [29]. Despite this, nurses demonstrated a good understanding of the importance of health-promoting activities. However, this knowledge does not translate into nurses’ self-care, which was evident in nonadherence to healthy behaviours [30]. Nurses in many studies reported several barriers to engagement in healthy self-care activities, including lack of time, high workload, occupational stress, shift work, lack of adequate resources and facilities, lack of sleep, fatigue, outside commitments, financial issues, and religious beliefs [31,32]. Our findings have implications for health promotion policies for nurses and supportive work environments. Our study suggests that leaders in health care institutions in Bahrain should consider ways to promote the health of their nursing staff by improving working conditions and providing access to facilities and programs that promote health and wellbeing. Another important implication of our study is about nurses’ role in promoting health and raising awareness of overweight and obesity. Being overweight or obese may limit this vital role because knowledge users may not view nurses as role models due to this contradiction.

The self-reported musculoskeletal study, which generated the data for this study involved 550 participants. If we estimated the sample size using Cochran’s formula and 50% as an average for the prevalence of overweight and obesity in the previous studies, 357 participants would be required. Therefore, the sample size of the original study was large enough to estimate the prevalence of both overweight and obesity. However, this study has some limitations. First, we obtained self-reported height and weight rather than objective measures. As a result, the weight and/or height could be either overestimated or underestimated by some of the participants. Second, the study was conducted at only three hospitals, thus limiting the generalization of findings to the entire nursing population in the Kingdom of Bahrain. Third, the prevalence of overweight and obesity was estimated at a single time point. A multipoint prevalence should be considered to best estimate the extent of the problem.

Conclusion

Our study findings contribute to the baseline knowledge of overweight and obesity among nurses in GCC countries. The most significant outcome of this study was that overweight and obesity were highly prevalent among nurses, as 64% of the study sample had a BMI above 25 kg/m2. We used BMI to estimate the prevalence of overweight and obesity, which is widely used in the literature. However, BMI does not consider muscle mass, bone density, overall body composition, and racial and sex differences. Therefore, in future studies, body fat proportion and muscle mass need to be measured to estimate the prevalence and predict risks for disease development, morbidity, and mortality.

Declarations

Ethics approval and consent to participate

All methods were carried out in accordance with relevant guidelines and regulations. Ethical approval for the musculoskeletal self-reported symptoms study was obtained from the Research Ethics Committee at the Royal College of Surgeons in Ireland, Medical University of Bahrain. We obtained permission from the administrations at the study hospitals and centres to access and recruit the participants. Informed consent was obtained from all participants included in the original study

Consent for publication

Not applicable 

Availability of data and materials

The data of this study are available from the corresponding author (HN) upon request.

Competing interests

The authors declare that they have no competing interests.

Funding

This research was not funded 

Authors' contributions

HN conceived and designed the study and is the primary investigator for the study. RH analysed the data. HN and MA drafted the article. All authors contributed to interpretation of the data and drafting revised versions of the manuscript and gave their final approval of the version to be published. All authors read and approved the final manuscript.

Acknowledgements

The authors thank the study participants and hospitals administration for granting access of their staff.

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